Chief Physician Old Pan straightened his back and tightly clenched his fists as he fixed his full, attentive gaze on the screen.
There was a temporary halt in comments on the live stream as every viewer finally realized that this was indeed an appendectomy with an incision made on the right hypochondrium region.
The comments started flowing again forty-seven seconds later.
[What the f*ck… What an awesome surgeon.]
[How did he come to that diagnosis when none of the preoperative investigations showed evidence of an ectopic appendix? I'm convinced that the surgeon must have hidden some investigative results.]
[You say it like you'd have the courage to diagnose such after performing a lower abdominal MRI scan. Mortals, tremble before your God.]
Zheng Ren's hands were stable, with slow but precise movements.
Since the appendiceal artery was engorged and edematous, Zheng Ren chose to perform stitch ties instead of a conventional ligation technique. His hands started dancing again, weaving the needle within the five square centimeters with ease.
The purulent appendix was resected and thrown into a specimen container along with the forceps.
Zheng Ren held his hand out again but this time, Xie Yiren's movement was sluggish, as if she was hesitating.
Zheng Ren, who was staring at the operative field attentively, seemed to understand the cause of her hesitation. Thus, he said without looking at her, "Small curved forceps and surgical scissors."
"The peritoneal cavity should be irrigated with normal saline after the resection of the appendix. What does he want to do with those instruments?" asked a random observer in the surgical demonstration classroom.
It was a question thrown without the blatant contempt that hung in the air before the surgery had even begun.
The surgery aside, that an ectopic appendix was accurately diagnosed was enough for any surgeon to gloat for a lifetime.
Moreover, the operation was done very beautifully. The whole process from the incision to the current procedure took only three minutes, and that included half a minute of pus aspiration.
Anyone with a doubt in their mind in that instant fought the urge to ask questions to prevent themselves from being humiliated. Even if an inquiry was made, its voice would be so soft that it would almost sound like unspoken criticism.
[Small-sized curved forceps? Surgical scissors? What for?]
[The appendix was resected, so what is he going to do now? Demon, that's a marvelous performance. Please give us a classic memory and don't screw it up.]
[What do you even know? He's much better than you.]
Xinglin Garden was indeed a website for adepts. Once they witnessed the mind-blowing skills of the surgeon, more than half of the viewers started expressing their admiration.
Birds of a feather flock together, and those willing to spend time on this website were experts who valued skills and professionalism.
It was their nature to worship anyone who could execute such a high-performing surgery.
[He is debriding the abscesses on the wall of the gallbladder!]
[Oh my God, is he not worried about damaging the edematous gallbladder?]
[Worship! Which hospital is this daemon working? I'm going to go further my studies!]
Chapter 14 - Postoperative Evaluation, Perfect!
The operative site had a very limited field of vision. Back in the day, Zheng Ren definitely would not have completed a surgery under such circ.u.mstances.
A restrictive line of sight increased the degree of difficulty of surgery tremendously.
However, after continuously performing more than two thousand appendectomies in the intensive training provided by the System, he had acclimatized the operative view of a tiny surgical opening.
It was impossible to attain the perfect standard required by the System with a large incision anyway, as it was simply too messy and amateurish.
If this was an ordinary surgery, the operation would have been declared successful once the inflamed appendix was resected. The following steps would be peritoneal cavity irrigation with normal saline, topical administration of antibiotics and finally, surgical wound closure.
However, that was nowhere close to perfection. At the upper right corner of Zheng Ren's vision laid a surgical progress bar which stated [86 percent].
Excellent rating only. Not enough yet.
What Zheng Ren needed to do right now was to debride the abscesses on the surface of the gallbladder wall so that antibiotics could take effect as soon as possible.
The gallbladder was edematous due to bacterial infection and caused its surrounding walls to be fragile, like a delicate porcelain vase.
It was beyond question that the 86 percent shown in the progress bar would reduce to negative instantly if there was an iatrogenic perforation of the gallbladder wall.
This procedure put not only the patient's life at risk, but also Zheng Ren's. Thus, extreme vigilance was compulsory and negligence was not an option in this situation.
Both the medium-sized curved forceps and the surgical scissors were in his right hand, with the finger holder of the scissors hanging on his right thumb. Depending on what was required, the positions of these two instruments could be swapped easily with a gentle flick of his fingers.
His hand movements were gentle and proficient as he dissected the abscesses from the surface of the gallbladder wall using the blunt end of the surgical scissors, which hung on his thumb most of the time.
Sea City General Hospital was well-equipped with advanced demonstration hardware for learning purposes. There were two monitors in the surgical demonstration classroom—one for the panoramic view of the surgical field, and the other connected to the camera in the surgical lighthead. The camera was able to capture everything the light touched, and so blindspots were essentially nonexistent as the surgery was projected onto the classroom screens.
Zheng Ren's hand movements were displayed very clearly when the second screen was set as the main view of the surgical field.
"That is skillful, but why does it look so familiar?"
"The way he uses the surgical scissors and medium-sized forceps…"
Chief Surgeon Liu's expression darkened instantly upon hearing the discussion behind him.
On the other hand, Chief Physician Old Pan was not in a good mood, either. He believed Zheng Ren was simply gilding the lily in debriding the abscesses from the surface of the gallbladder wall, since the patient's immune system could deal with them postoperatively with no issue.
At least the risk of surgical failure would be minimal even if the patient had to be discharged a few days late. The game was not worth the candle if surgical complications arose because of this unnecessary procedure.
The chat room in Xinglin Garden was overwhelmed with comments.
The view of the surgical field in the live broadcast was much clearer and direct than the projector screen used in Sea City General Hospital's surgical demonstration classroom.
[The surgery and live broadcast are amazing and professional. Is it possible that some live broadcast platform is going to start livestreaming surgeries and came here to test the waters?]
[Don't be ridiculous. There are less than a hundred surgeons in this country who can perform such an outstanding surgery. No matter who he is, it's impossible that he would visit any live broadcast platform to livestream his surgery.]
[The blunt dissections were done beautifully. My fifty-meter surgical sword is craving blood. Fortunately, I have surgery this evening. I'm going to try it out later.]
After worshipping a god, it was time for reassessment, amelioration, and experiments.
Every doctor… Well, most doctors possessed this insatiable hunger for knowledge.
Each and every comment transformed into specks of light, invisible to the n.a.k.e.d eye, which passed through the dimensional barrier and flew right into the fox statue in the System.
Slowly but surely, the spacial distortion
in the System stabilized.
"Warm normal saline and gentamicin irrigation." Zheng Ren sighed in relief as the last abscess was dissected. Staring at the transparent screen on the upper right corner of his vision which showed 97 percent, his initial anxiety was slowly replaced with calm.
Based on Zheng Ren's experience, that number would reach 100 percent as long as he followed basic surgical steps—irrigation and abdominal surgical wound closure, which meant that he had performed this appendectomy surgery perfectly.
Success!
After the warm normal saline was handed over, Zheng Ren started pouring it along the tiny surgical incision into the peritoneal cavity and waited for twenty seconds before aspiration was initiated.
Meanwhile, Xie Yiren filled the syringe with gentamicin and removed the needle before passing it to Zheng Ren.
He injected gentamicin into the peritoneal cavity slowly before starting abdominal wound closure.
Some liked to use powdered antibiotics from the cephalosporin family while others preferred to use old-fashioned gentamicin for intr.a.p.eritoneal administration of antimicrobials.
Zheng Ren belonged to the latter group.
There was a subtle difference between these two options. Based on Zheng Ren's experience after thousands of surgical practices in the System, he concluded that gentamicin was more suitable for this patient's current condition.
The abdominal incision was small so its closure could be done in a short amount of time.
However, Zheng Ren dared not loosen up or let his guard down because he was unsure whether he was given only ten surgeries to perform perfectly or if ten perfect surgeries were required from a hundred. God only knew what the System actually wanted with him…
He had no choice but to put pressure on himself. He needed to perform ten operations and all of them had to achieve perfection.
Each layer of the abdominal cavity was sutured accordingly. Once Zheng Ren reached the skin layer, he hesitated for a while before asking for a 3-0 absorbable suture for a running subcuticular suture technique.
This surgery was officially complete, according to Xie Yiren.
She relaxed and smiled. "Doctor Zheng, the patient is a forty-year-old man. I don't think an abdominal scar is a concern to him at all."
"I just want to do everything perfectly," replied Zheng Ren while continuing closure of the surgical wound.
"Young female patients will feel blessed under your care in the future," Xie Yiren smiled in response.
"Yes. I can make it woundless if it's just a simple appendicitis case," replied Zheng Ren.
Xie Yiren was stunned momentarily. Woundless? Doctor Zheng must be joking with her.
Yes… it must be a joke.
Even though Xie Yiren did not assist Zheng Ren in the operating theater frequently, it was perfectly normal for a surgical team to tell funny stories or make dirty jokes in order to maintain a joyful and tension-free atmosphere in the operating theater.
Chapter 15 - Dental Prosthesis and Primary Cell
Zheng Ren's words were captured by the microphone, processed by the audio transmission system, and broadcast through the speakers of the surgical demonstration classroom.
"Outrageous!" shouted Chief Surgeon Liu when he finally found a flaw in this surgery.
"Chief Surgeon Liu, why convert your shame into rage? Zheng Ren was just making a joke. Besides, he wasn't cracking jokes with you, so why are you even mad at him?" replied Chief Physician Pan with a wide grin.
"As a rigorous and strict surgeon, what will they think of us when such irresponsible jokes are spread publicly?" criticized Chief Surgeon Liu, who was trying to add fuel to the fire.
Since Chief Physician Pan had won this competition, he was able to cross swords with Chief Surgeon Liu with ease and instantly changed the argument from the woundless appendectomy to the misdiagnosis by the first general surgery department.
The continuous fire forced Chief Surgeon Liu to flee the battlefield.
[Finishing an appendectomy with a continuous suture technique with an absorbable suture to achieve minimal scarring effect. Is he demonstrating a perfect surgery—without any flaws at all?]
Comments continued to overwhelm the chatroom of Xinglin Garden.
For doctors who watched live streams, the initiation of peritoneal cavity irrigation basically signified the end of a surgery.
[Of course. It's extremely difficult to conclude that an appendix is in an ectopic position, but he diagnosed it without hesitation and even turned on a live broadcast of the surgery with confidence. I'm guessing that the surgeon is Lecturer Zhang from Union Medical College Hospital.]
[Impossible. Lecturer Zhang wouldn't broadcast his surgery.]
Most of the viewers typing '6661' in their comments were trying to guess the surgeon's identity as well.
No matter who they guessed, one thing was for sure—this surgeon had earned their respect. This was a flawless surgery that could become learning material in medical textbooks.
There was no audio in the livestream, so none of the viewers heard the woundless appendectomy Zheng Ren mentioned.
The surgery progress bar reached 100 percent as soon as Zheng Ren cut the suture thread. A perfect surgery!
After Zheng Ren changed into a normal attire and returned to the first general surgery department, Old Chief Physician Pan gave him a huge thumbs-up.
It was an old-fashioned style of expressing his joy, but that was how Old Chief Physician Pan complimented and approved Zheng Ren from the depths of his heart.
On the other hand, Zheng Ren's colleagues in the first general surgery department appeared dispirited and their gazes on him were foreign and adrift.
"Let's take a break and eat," said Old Chief Physician Pan as he tapped Zheng Ren gently on the shoulder and pushed him toward the exit.
However, food and rest were not Zheng Ren's main concern at the moment. His sharp eyes noticed that the transparent screen on the upper right corner of his vision seemed to have become clearer after the surgery was completed.
He needed to confirm something urgently. It was a life-and-death situation.
Old Chief Physician Pan's eyelids flickered momentarily as Zheng Ren rejected his kind offer. Left with no choice, he invited Xie Yiren to grab a casual meal.
Zheng Ren returned to the emergency department, turned on his cell phone, and ordered a set of dumplings with chives and egg fillings.
Since the food delivery rider would arrive with his food twenty minutes later, Zheng Ren made use of this time to lie on the bed in the male on-duty room, closed his eyes, and entered the mysterious world in the System.
The scenery remained the same as where he left last time. The only notable difference was the constant alteration in the color of everything in the world.
When he entered the System and was assigned a mission to complete ten perfect surgeries last time, the mysterious world was etched in gray as if a dust storm had rampaged through it.
Now, it seemed that all the color had been restored and this place was starting to brim with life and vitality again.
There was a huge change in his skill tree as well, from a Graduate rank with 330 skill points to the Expert rank with 1005 skill points.
Was this the result of the intensive training? Wow, was he that amazing already? It was unbelievable. At the same time, Zheng Ren felt exhilarated.
"Hello, anyone here?" yelled Zheng Ren.
No response, as usual…
What a strange System. Was it programmed not to communicate with the host at all? Well, Zheng Ren came here last time and was told that failure to complete the mission would end up in peril. That suggested the System lacked emotional intelligence entirely.
After making some silent complaints and failing to find any clues, he summoned his consciousness back to reality.
At least he learned something from this visit. He presumed the System had run out of power and required some sort of method to 'recharge' its energy.
Perhaps the completion of a perfect surgery was its method, after all.
That was a wild stretch of his imagination for a surgeon, but Zheng Ren had no other explanation.
Fortunately, he was off to a good start today. His first surgery was a complicated case of acute phlegmonous appendicitis with an ectopic appendix.
Most importantly, Zheng Ren's general surgery skill had reached the Expert rank, which boosted the junior attending surgeon's confidence tremendously.
Hopefully, the next few surgical cases were some simple, uncomplicated appendicitis cases. It was better not to take any risks and survival was of utmost importance in this situation.
His colleagues in the emergency department felt a little conflicted when they saw his arrival.
Those who were transferred to the emergency department were usually ordinary, unmotivated doctors, who had either been cast aside by their original department or merely wanted to rest for three to five days after being on call for twenty-four hours.
If an emergency operating theater was successfully established in the emergency department, did it mean that everyone would have an increased workload with greater responsibility?
Most doctors in the emergency department were in their forties. If they were willing to live their life as useless and indolent sloths, nobody could persuade them otherwise, not even the aggressive senior military doctor, Chief Physician Pan.
Well, none of them were Zheng Ren's business. All he needed to do right now was to wait patiently for the arrival of the next appendicitis case.
The emergency department increased in activity as the sun sank lower in the sky.
Various emergency cases—motor vehicle accidents, drunken brawls, acute gastroenteritis due to binge-eating, alcoholic intracerebral hemorrhaging, and myocardial infarctions—arrived at the emergency department, but not a single appendicitis case appeared.
Zheng Ren felt slightly helpless and dispirited, but it seemed inappropriate to pray for more appendicitis cases in Sea City solely for his own survival.
The Surgeon's Studio c1-799 Page 11
